Provider Demographics
NPI:1528291424
Name:MELROSE FAMILY OPTICIANS LLC
Entity type:Organization
Organization Name:MELROSE FAMILY OPTICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-665-0897
Mailing Address - Street 1:490 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3841
Mailing Address - Country:US
Mailing Address - Phone:781-665-0897
Mailing Address - Fax:781-665-8828
Practice Address - Street 1:490 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3841
Practice Address - Country:US
Practice Address - Phone:781-665-0897
Practice Address - Fax:781-665-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty